Selective double disconnection for cirrhotic portal hypertension

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatology

Background:

• Portal hypertension (PHT) is a serious condition often leading to variceal bleeding.
• Current surgical interventions for PHT carry significant risks and complications.
• Evaluating novel surgical techniques is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the efficacy and safety of selective double portazygous disconnection with preserving vagus (SDPDPV) for cirrhotic PHT patients.
• To compare SDPDPV with pericardial devascularization with splenectomy (PDS) in managing variceal bleeding.
• To assess the impact of SDPDPV on postoperative complications and long-term survival rates.

Main Methods:

• Retrospective review of 453 cirrhotic PHT patients undergoing either SDPDPV or PDS for variceal bleeding (February 2007 - January 2013).
• Analysis of operation-relevant data, laboratory results, postoperative complications, and clinical outcomes.
• Comparison of operative time, blood loss, portal pressure, liver function, Child-Pugh score, complication rates, and survival between the two surgical groups.

Main Results:

• No significant difference in operative time or intraoperative blood loss between SDPDPV and PDS groups.
• SDPDPV resulted in significantly lower post-operative free portal pressure compared to PDS.
• SDPDPV group showed significantly better preservation of hepatocyte function and less alteration in Child-Pugh score.
• SDPDPV significantly reduced the incidence of rebleeding, ascites, and gastric stasis compared to PDS.
• SDPDPV demonstrated significantly lower operative mortality and improved 3-year survival rates.

Conclusions:

• SDPDPV effectively controls recurrent variceal bleeding in patients with PHT.
• SDPDPV preserves normal gastric, intestinal, and hepatobiliary physiological functions.
• SDPDPV presents a superior surgical option compared to PDS for managing cirrhotic PHT with variceal bleeding.